I am now I'm now in my 9th year of maintaining a "normal" weight after a large weight-loss.

Accomplishing this has been incredibly hard, and, even after all these years, this task is not getting any easier for me.
See: Running DOWN the UP Escalator.

The Truth about weight-loss and maintaining weight-loss isn't something that we're EVER going to hear from Marketing Interests … (which includes most doctors and nutritionists) … however, Facing it, Understanding it, and Accepting it, can be very helpful.

Below is a recent CBS news article discussing this issue.

Obesity research confirms long-term weight-loss almost impossible. 
                          by Kelly Crowe, CBS news 6-4-14

There's a disturbing truth that is emerging from the science of obesity. After years of study, it's becoming apparent that it's nearly impossible to permanently lose weight.

As incredible as it sounds, that's what the evidence is showing. For psychologist Traci Mann, who has spent 20 years running an eating lab at the University of Minnesota, the evidence is clear. "It couldn't be easier to see," she says. "Long-term weight loss happens to only the smallest minority of people."

We all think we know someone in that rare group. They become the legends — the friend of a friend, the brother-in-law, the neighbor — the ones who really did it.

But if we check back after five or 10 years, there's a good chance they will have put the weight back on. Only about five per cent of people who try to lose weight ultimately succeed, according to the research. Those people are the outliers, but we cling to their stories as proof that losing weight is possible.

"Those kinds of stories really keep the myth alive," says University of Alberta professor Tim Caulfield, who researches and writes about health misconceptions. "You have this confirmation bias going on where people point to these very specific examples as if it's proof. But in fact those are really exceptions."

Our biology taunts us, by making short-term weight loss fairly easy. But the weight creeps back, usually after about a year, and it keeps coming back until the original weight is regained or worse.

This has been tested in randomized controlled trials where people have been separated into groups and given intense exercise and nutrition counseling.

Even in those highly controlled experimental settings, the results show only minor sustained weight loss.

When Traci Mann analyzed all of the randomized control trials on long-term weight loss, she discovered that after two years the average amount lost was only one kilogram, or about two pounds, from the original weight.

Tiptoeing around the truth

So if most scientists know that we can't eat ourselves thin, that the lost weight will ultimately bounce back, why don't they say so?

Tim Caulfield says his fellow obesity academics tend to tiptoe around the truth. "You go to these meetings and you talk to researchers, you get a sense there is almost a political correctness around it, that we don't want this message to get out there," he said.

"You'll be in a room with very knowledgeable individuals, and everyone in the room will know what the data says and still the message doesn't seem to get out."

In part, that's because it's such a harsh message. "You have to be careful about the stigmatizing nature of that kind of image," Caulfield says. "That's one of the reasons why this myth of weight loss lives on."

Health experts are also afraid people will abandon all efforts to exercise and eat a nutritious diet — behavior that is important for health and longevity — even if it doesn't result in much weight loss.

Traci Mann says the emphasis should be on measuring health, not weight. "You should still eat right, you should still exercise, doing healthy stuff is still healthy," she said. "It just doesn't make you thin."

We are biological machines

But eating right to improve health alone isn't a strong motivator. The research shows that most people are willing to exercise and limit caloric intake if it means they will look better. But if they find out their weight probably won't change much, they tend to lose motivation.

That raises another troubling question. If diets don't result in weight loss, what does? At this point the grim answer seems to be that there is no known cure for obesity, except perhaps surgically shrinking the stomach. 

Research suggests bariatric surgery can induce weight loss in the extremely obese, improving health and quality of life at the same time. But most people will still be obese after the surgery. Plus, there are risky side effects, and many will end up gaining some of that weight back.

If you listen closely you will notice that obesity specialists are quietly adjusting the message through a subtle change in language.

These days they're talking about weight maintenance or "weight management" rather than "weight loss."

It's a shift in emphasis that reflects the emerging reality. Just last week the headlines announced the world is fatter than it has ever been, with 2.1 billion people now overweight or obese, based on an analysis published in the online issue of the British medical journal The Lancet.

Researchers are divided about why weight gain seems to be irreversible, probably a combination of biological and social forces. "The fundamental reason," Caulfield says, "is that we are very efficient biological machines. We evolved not to lose weight. We evolved to keep on as much weight as we possibly can."

Lost in all of the noise about dieting and obesity is the difficult concept of prevention, of not putting weight on in the first place.

The Lancet study warned that more than one in five kids in developed countries are now overweight or obese. Statistics Canada says close to a third of Canadian kids under 17 are overweight or obese. And in a world flooded with food, with enormous economic interest in keeping people eating that food, what is required to turn this ship around is daunting.

"An appropriate rebalancing of the primal needs of humans with food availability is essential," University of Oxford epidemiologist Klim McPherson wrote in a Lancet commentary following last week's study. But to do that, he suggested, "would entail curtailing many aspects of production and marketing for food industries."

Perhaps, though, the emerging scientific reality should also be made clear, so we can navigate this obesogenic world armed with the stark truth — that we are held hostage to our biology, which is adapted to gain weight, an old evolutionary advantage that has become a dangerous metabolic liability. 

Dr. Yoni Freedhoff, whose new book, The Diet Fix is featured here in DietHobby's BookTalk section, made this comment about the above-quoted article:

 

I think what makes maintaining weight loss seem "almost impossible" are the goal posts society has generally set to measure success. 

 

No doubt, if the goal set is losing every last ounce of weight that some stupid chart says you're supposed to lose then the descriptor "almost impossible" may well be fair. 

On the other hand, if the goal is to cultivate the healthiest life that you can honestly enjoy, subtotal losses, often with significant concomitant health improvements, are definitely within your reach. 

Ragen Chastain of DanceswithFat says: 

If you read the comments on the article, you’ll see that many people subscribe to the magical power of semantics.  If you attempt intentional weight loss, but instead of dieting you call it a lifestyle change, they claim you won’t gain your weight back.  This is the second to the last stop on the denial train, at the final stop people just close their eyes, stick their fingers in their ears, and scream LA LA LA! 

Studies have shown that when people diet, their bodies change biologically for the express purpose or regaining and maintaining weight,

.... but it really doesn’t matter at this point why weight loss fails almost all the time.  The fact that it does means that weight loss does not meet the criteria of evidence based medicine.  If a prescription fails almost all the time, often having the exact opposite of the intended result, (and especially when that happens consistently for more than 50 years,) the solution is not to keep prescribing that intervention and tell people to try harder.

This is the world that diet culture built. Doctors, diet companies, internet commenters, people’s mamas and everyone else have been telling us that being thin is the only path to health and that if healthy habits don’t make us thinner than they won’t make us healthier.  Society says that the only “good” body is a thin body. Now we find that if healthy habits don’t make us thinner we “tend to lose motivation.”  I forget, what’s the word that means the opposite of “shocking”?

The solution is to stop worrying if the truth is “stigmatizing” and start telling the truth early and often.  Telling the truth with the same veracity that people post anti-fat, pro weightloss diatribes in the comment sections of every article that exists on the internet.

Public health should be about making as much true information and as many options as possible available to the public, and then letting people make their own decisions.

Health is not an obligation, a barometer of worthiness, or completely within our control. Each of us gets to choose how highly we prioritize our health and the path that we want to take to get there and those decisions can also be impacted by forces outside of our control.

The other part of the solution is to stop stigmatizing fat people. The article waxes tragic about the fact that fat people are unlikely to get thin, but the truth is we have no idea what our health would be like if fat people weren’t faced by constant stigma.  We have no idea what our health would be like if fat people stopped feeding our bodies less fuel than they need to survive in the hopes that they will eat themselves and become smaller (aka weight loss). Since statistically the best way to gain weight is to diet, we don’t know what our society body size distribution would look like if we stopped doing it. Maybe if enough people refuse to perpetuate the lie of weight loss and start telling the truth, we can find out.

My own view is, that just because something is hard, doesn't mean it is impossible.  

Losing weight is hard.
Maintaining weight-loss is hard.  
Being fat is hard.  
Choose your hard.
  

Each of us needs to decide for ourselves, whether or not we want to attempt to "climb the weight-loss mountain", and, if so, what individual path will work best for us personally. 

Yesterday I answered a question from a member of a forum that I frequent.  I'm doing that again today. 

         Forum Member Asked:  

"What percentage would you say .. of those with above-normal BMI's are seriously obese? I'm pretty sure the morbidly obese comprise under 10%, but would you include others in the seriously obese category?"

 I found this an interesting question.  I thought about it; did some research; made some rough calculations; and came up with the following answer. 

There are "official" stages of obesity, using the BMI. 

Stage 1 is 30 - 34.9 BMI -- obesity

Stage 2 is 35  - 39.9 BMI -- severe obesity

Stage 3 is 40 - 49.0 BMI - morbid obesity

Stage 4 is 50 and up BMI - super obesity

Personally, I would include most of the Stage 2, severe obesity people into what I term the "seriously obese category", depending on the number of years they've spent above Stage 1.

About Percentages … roughly based on a 2010 survey of the US population,

73% of the US population is overweight or obese. 

The Percentage breakdown for women over the age of 20 is: 
 

64% of women over 20 - either overweight or obese 

36% of these women - are obese. 

The Percentage breakdown for Obese women over the age of 20 is: 

36% Obese. with …  

Stage 1 --Obese = 17%

Stage 2 -- Severely Obese = 11%

Stage 3 -- Morbidly & Super Obese  = 8%

However, note that these are the percentages of the overweight and the obese women within the general population.

When considering only the Diet Community population,  the Overweight and Obese breakdown is approximately 100% of the diet community population, rather than the 64% that is within the general population.

Of that 100%, there is no way to actually KNOW the breakdown between overweight and obese.. but common sense and my observational skills tell me that most women who join dieting communities are commonly near or above the obesity borderline, so the percentage of those obese dieters joining diet communities is higher than the 56%  which would be allotted through changing the 64% to a 100% breakdown. 

Assigning percentages of those obese dieters to stages 1, 2, 3, and 4 would merely be further guesswork.  However, if we based percentages proportionally.. which, of course, would be inaccurate…. Approximately….

47% of these obese people would be stage 1 - obese,

30% of these obese people would be stage 2 - severely obese

22% of these obese people would be stage 3 or 4 - morbidly or super obese

Dragging this out to absurdity…

the percentage of the dieting community which is obese .. rather than overweight.. could be at least  two-thirds (63%) or higher..more than one-half (52%) of that two-thirds would be severely or morbidly obese. ..meaning about 33% of 100% would fall into the category of severely obese or above. 

The absurdly-inaccurate general calculations above support my own personal estimate which is that probably about one-third or higher of the diet community population consists of women who I would term as "seriously" obese.  

 Twenty-two years ago, my own highest BMI was 52.9 which placed me into the Stage 4 category - super obese.  However, my lifetime of continual dieting allowed me to spend the majority of my years between the ages 20 and 50 with a BMI from 35 to 39 -- within Stage 2, the severely obese range. It has only been within the past 9 years that I have been in the "normal" BMI range.

                     
Here's some interesting information.

Managing Weight Loss Expectations
          by Dr. Arya Sharma, M.D. Dr. Sharma's Obesity Notes

While there are almost no limits to short-term weight loss goals (anyone can starve themselves thin) – the reality of long-term weight loss is rather sobering.

While diet and exercise generally provide an average long-term (3-5 years) sustainable weight loss of about 3-5% of initial weight, even bariatric surgery patients tend on average to sustain a weight loss of only 20-30% of their initial weight.

Surgery, although much safer than generally thought, still bears a risk of complications and the question is how much risk patients are willing to assume if they really knew and understood how much weight they are likely to lose with surgery.

This was the subject of a study by Christina Wee and colleagues, published in JAMA Surgery, in which they examined weight loss expectations and willingness to accept risk among patients seeking bariatric surgery.

The researchers interviewed 650 patients interested in bariatric surgery at two bariatric centres in Boston.

On average, patients expected to lose as much as 38% of their weight after surgery and expressed disappointment if they did not lose at least 26%.

In fact, 40% of patients were unwilling to undergo a treatment that would result in only 20% weight loss.

Most patients (85%) accepted some risk of dying to undergo surgery, but the median acceptable risk was only 0.1%.

On the other hand, some patients (20%) appeared more desperate, willing to accept a risk of 10% or greater.

As one may expect, there were important gender differences in these findings: while women were more likely than men to be disappointed with a 20% weight loss, they were also less likely to accept a greater mortality risk.

An important finding for clinicians was that patients with lower quality-of-life scores and those who perceived needing to lose more than 10% and 20% of weight to achieve “any” health benefits were more likely to have unrealistic weight loss expectations.

This study not only shows that most patients seeking bariatric surgery have rather unrealistic weight loss expectations but also that a substantial number may well be be disappointed with their weight loss after surgery.

It is also evident that many patients believe that they need to lose a rather substantial amount of weight to derive “ANY” health benefits, when in reality even rather modest (and certainly the average 20-30% weight loss seen with surgery) carries substantial health benefits for patients. (Many patients would in fact benefit substantially if they simply stopped gaining weight).

I certainly wonder what educational efforts may be necessary to align expectations with the clinical reality of bariatric surgery and whether better managing expectations is likely to alter current practice?

None of this information is surprising to me.  I've both read it and witnessed it again and again.

Permanent weight-loss is so incredibly difficult.  Right now, even short-term weight loss feels impossible.  At present, I'd feel grateful to see any kind of weight-loss take me back down nearer to my goal weight. Weight-loss somehow has to occur in the first place, BEFORE it can become permanent.  After all, every weight-loss is short-term until it becomes permanent.

Most people will find this entire article discouraging, 
 However, to show where MY head is at ... right now, the following statement at the beginning of this article actually made me feel unexpectedly HOPEFUL.

"...there are almost no limits to short-term weight loss goals 
    (anyone can starve themselves thin)... "

22 years ago at age 47, weighing 271 lbs. at a height of 5'0",  I had an RNY gastric bypass, open surgery, with NO removal of any intestine, which means that every calorie I eat is still digested, and still counts. 

The doctor's recommendation for post-surgery eating was simple. "Eat three meals a day of whatever food you want, but make half of each meal protein; avoid fried foods and sweets; and have no carbonated beverages."

My surgery was done when the procedure was still considered experimental.  At the time, it was performed here in California by only a few doctors. To get surgery, people had to travel to San Diego, stay in the hospital 2 or 3 days, then stay at a local hotel for an additional 10 post-surgery days before being released to return back home.  Follow-up care was received once a month during the surgeon's visit to one of the nearby temporary clinics located in various cities throughout California.  About five years later,  surgeons all over California began setting up specialized practices for weight-loss surgery, and coordinated with nutritionists who made specific post-surgery diet recommendations like protein shakes etc. That happened several years before laser surgery became common.

The first year after surgery my body would tolerate very little food.  Eating more than one-quarter to one-half cup of food at a time made me feel uncomfortably stuffed like after Thanksgiving dinner.  

I frequently experienced Dumping syndrome, which is caused by food passing too quickly into the small intestine. This caused immediate symptoms of flushing, weakness, fatigue, dizziness, and an intense desire to lie down. Severe episodes include feelings of nausea, and even stomach cramps.

I experienced severe dumping symptoms after just a swallow or two of fruit juice; or one or two bites of fried-or-greasy food; or a bite or two of any sweet like cookies, cake, pie, candy. I also became lactose intolerant. Milk made me feel ill, and even the tiniest bit of ice cream, with it's combination of milk and sugar, immediately made me lie-down-with-dry-heaves-ill.

Therefore, due to my weight-loss surgery, that entire first year my food intake was somewhere between 200 to 600 calories a day, which caused my weight to drop from 271 down to 161 lbs .... without dieting. This happened while I ate however much I could, of whatever food my body would tolerate.  The reason I did not binge, cheat, or quit, even when my weight-loss was slower than I believed I deserved, was because it was physically impossible for me to do so. 

Most people think that weight loss after WLS always happens rapidly.  That immense amounts of weight fall off everyone's body every week, 5-10-15 pounds, week-after-week, like on the Biggest Loser tv show.. only maybe even faster. 

However, Real Life AFTER a Gastric Bypass Surgery, works just like Real Life BEFORE a Gastric Bypass Surgery.  Even though after a RNY surgery Everyone has a smaller stomach, and Everyone eats just a small amount, the rate of weight-loss continues to be an individual matter.  Some people's bodies simply drop weight faster than other people's bodies, and surgery doesn't change that fact. 

Below is a graph of my own individual weight-loss results. This is what happened to MY body during the 64 weeks after a RNY gastric bypass surgery.  I did not diet during that time, but the surgery severely restricted what I ate, and the amounts I ate. I was physically unable to cheat, and I was physically unable to quit.  Plus, of course, I was strongly motivated to lose weight.  Remember, I was a 48 year old, sedentary female who was only 5 ft 0 in tall.

For the next 2 to 3 years I maintained in the 160s while eating as much food as my body would tolerate, however, my stomach begin stretching, and my body began to tolerate more food, and again, I had to begin dieting to keep my weight down.

For the next 10 years, I worked at dieting to keep my weight down, but my weight kept creeping up. I felt I simply could not bear weighing over 200 lbs again, after all my effort, pain, and expense. My struggle to avoid gaining more weight allowed me to maintain in the 190s for several years.  In September 2004 I began logging my food into DietPower, which is a computer software food journal that I discovered online.

At that point, I begun losing weight, and about 16 months later, after working to eat a daily average of approx 1230 daily calories, I reached my goal weight of 115 lbs.

During all of the 8+ years since that time I've been working to maintain at or near that goal weight.

SO ....to summarize the NEXT SEVERAL YEARS: 

Without Dieting

Maintained in the 160's the following 2 ½ years until weight crept into the 170s.  

Started Dieting again, with following Results.

Back to the 160's for 4 months, then weight crept back up into the 170s.

Maintained in the 170's for 2 years, then weight crept on up into 180's. 

Maintained in the 180's for 2 years, then weight crept on up into the 190's

Maintained in the 190s for 2 years,  

          Next

Started Dieting Successfully - began tracking food daily using computer software.

September 20, 2004 - weight 190

January 27, 2006 - weight 115

8+ years later, now in 9th year of dieting to maintain weight-loss.  

Total Summary: 

            Weight                        Weight                  

Pre Surgery …...     241            Reached.... ...... 161  =   110 pound Loss

Post surgery …..     161      Regain….....… 190   =     29 pound Gain

Food Tracking...     190           Goal reached….115  =      75 pound Loss

For further information see the section ABOUT ME here at DietHobby.

 
Much of the weight-loss and maintenance information available to us is both inaccurate and unhelpful. Like Dorothy of Oz and Alice of Wonderland, during my lifetime of research on those issues, I've seen some "weird shit".

Here in my DietHobby online scrapbook I work to sort out and save reasonably accurate information that might prove helpful to me and perhaps to others.

The article below deals with the issue of Energy In and Energy Out, which is not as simple as most people believe.

People have different body weights because each of them has an individual physiology and psychology which ultimately determines their own individual levels of "energy in" and "energy out" AND which also determines how their own individual bodies respond to it. 

A snapshot of the unaveraged data contained in scientific research of Individual BMR or RMR (metabolism rates) bears a strong resemblance to a blood spatter pattern at a violent crime scene. Metabolism rates are all over the place, but these widely varying numbers are then averaged out to create the calculations we see formulas like Harris-Benedict, Mifflin, etc.  An Average is a Statistical number for mathematical convenience. It is not an accurate number for Everyone, and sometimes is not even accurate for Anyone ... similar to the following joke: 

A biologist, a chemist, and a statistician are out hunting.  The biologist shoots at a deer and misses fifteen feet to the left, the chemist takes a shot and misses fifteen feet to the right, and the statistician yells "We got 'em!"

People the same sex, age, and size can take in the same amount of "energy" and do their best to engage in the same amount of activity, but wind up with very different weight results. 

In tightly controlled feeding studies, the same absolute amount of extra calories can result in very different amounts of weight gain. Also, the exact same amount of caloric deficit will result in widely different amounts of weight loss. 

In general, this basic fact of human nature is overlooked, or ignored. 

Here is a recent article by obesity specialist, Dr. Sharma addressing this problem. 

Why The Energy Balance Equation Results In Flawed Approaches To Obesity Prevention And Management

    by Dr. Arya Sharma, MD 
         @ Dr Sharma's Obesity Notes 

Allow me to start not with the first law of thermodynamics (energy cannot be created or destroyed) but rather, the second law of thermodynamics, according to which entropy (best thought off as a measure of disorder), in any closed system, increases till it ultimately reaches thermodynamic equilibrium (or a state of complete disorder).

As some of us may recall from basic biology, the very definition of “life”, which tends to move from a state of lesser organization to a state of higher organization, is that it appears to defy the second law of thermodynamics (this is often referred to as “Schroedinger’s Paradox”).

In actual fact, we can easily argue that the second law does not apply to living organisms at all because living organisms are not closed systems and life’s complex processes continuously feed on its interactions with the environment.

Yet, when we consider the first law of thermodynamics and how it applies to obesity, we seem to forget the fact that we are again dealing with a complex living organism.

Thus, in what has been referred to as the “Folk Theory of Obesity”, we simply consider weight to be a variable that is entirely dependent on the difference between energy input and energy output (or “calories in” and “calories out”). And in our arithmetical thinking, we consider “energy in” and “energy out” as simple “modifiable” or “independent” variables, which if we can change, will result in any desired body weight.

In fact, our entire “eat-less-move-more” approach to obesity is based on this concept – the central idea being, that if I can effectively move “energy in” and “energy out” in the desired directions, I can achieve whatever weight I want.

This notion is fundamentally flawed, for one simple reason: it assumes that weight is the “dependent” variable in this equation.

However, as pointed out in a delightful essay by Shamil Chandaria in my new book "Controversies in Obesity", there is absolutely no reason to assume that weight is indeed the “dependent” or “passive” player in this equation.

Indeed, everything we know about human physiology points to the fact that it is as much (if not more) body weight itself that determines energy intake and output as vice versa.

Generally speaking, heavier people tend to eat more because they have a stronger drive to eat and/or need more calories to function – in other words, body weight itself may very much determine energy intake and output (and not just the other way around).

Similarly, losing weight tends to increase hunger and reduce energy expenditure – or in other words, changes in body weight can very much determine changes in energy intake and expenditure (and not just the other way around).

Thus, the idea that we can control our body weight by simply controlling our energy intake and output, flies in the face of the ample evidence that it is ultimately our physiology (in turn largely dependent on our body weight) that controls our energy intake and output.

Thus, to paraphrase Chandaria’s key argument, it is not so much about what “energy in” and “energy out” does to our body weight – it is more about what our body weight does to “energy in” and “energy out”.

Once we at least accept that this equation is a two-way street, rather strongly biased towards body weight (or rather “preservation of body weight”) as the key determinant of “energy in” and “energy out”, we need to ask a whole different set of questions to find solutions to the problem.

No longer do we restrict our focus to the exogenous factors that determine “calories in” or “calories out” (e.g. our food or build environments) or see these as the primary targets for decreasing caloric intake or increasing caloric output.

Rather we shift our focus to the physiological (and psychological) factors (often dependent on our body weights) that ultimately dictate how much we “choose” to eat or expend in physical activity.

Chandaria’s essay goes on to discuss the many “derangements” of physiology that we know exist in obese individuals (and probably already exist in those at risk for obesity), including leptin resistance, impaired secretion of incretins like GLP-1, insulin resistance, alterations in the hypothalamic-pituitary-adrenal (HPA axis), and sympathetic activity. (Any keen student of human physiology or psychology should have no problem further extending this list.)

In Chandaria’s view, it is these physiological (and psychological) processes that ultimately determine whether or not someone is prone to weight gain or ultimately gains weight.

In fact, the only factor that determines why two individuals living in the same (obesogenic) environment will differ in body weights (even when every known social determinant of health is exactly equal), is because of their individual physiologies (and psychologies) which ultimately determine their very own individual levels of “energy in” and “energy out” (and how their bodies respond to it).

Readers may be well aware that in tightly controlled feeding studies, the same absolute amount of extra calories can result in very different amounts of weight gain.

Similarly, the exact same amount of caloric deficit will result in widely different amounts of weight loss.

Ignoring this basic fact of human nature distracts or, at the very least, severely limits us from finding effective solutions to the problem.

This “physiological” view of the first law of thermodynamics should lead us away from simply focusing on the supposedly “exogenous” variables (“energy-in” and “energy-out”) but rather draw our attention to better understanding and addressing the biological (and psychological) factors that promote weight gain.

This would substantially change the aims and goals of our recommendations.

Thus, for e.g., rather than aiming exercise recommendations primarily at burning more calories, these should perhaps be better aimed at improving insulin sensitivity and combating stress. Thus, rather than counting how many calories were burnt on the treadmill, the focus should be on what that dose of exercise actually did to lower my insulin or stress levels.

Indeed, we may discover that there is a rather poor relationship between the amount of calories burnt with exercise and the physiological or psychological goal we are trying to achieve. While more exercise may well help burn more calories (which I can eat back in a bite or two), it may do little to further improve insulin resistance or combat stress thus leaving my weight exactly where it is.

Similarly, rather than trying to restrict caloric intake, dietary recommendations would be based on how they affect human physiology (e.g. gut hormones, reward circuitry or even gut bugs) or mood (e.g. dopamine or serotonin levels).

In other words, fix the physiology (or psychology) and “calories in” and “calories out” will hopefully fix themselves.

Given that our past efforts primarily focusing on the “energy in” and “energy out” part of the equation have led nowhere, it is perhaps time to focus our attention and efforts elsewhere.

Or, as I often say in my talks, “We’re not talking physics here – we're talking physiology – that’s biology messing with physics”.

We cannot mess with the physics but we sure can mess with the biology.

Shamil A. Chandaria: The Emerging Paradigm Shift in Understanding the Causes of Obesity. In Controversies in Obesity.  Eds: Haslam DW, Sharma AM, Le Roux CW. Springer 201